Skin Cancer xxix, 2011 : Page 18

BEAUTY Tanned skin is not, nor has it ever been, a universally accepted ideal. — THE TALE OF TANNING: FROM PALE TO BRONZE AND BACK AGAIN. (P .20) THE TALE OF TANNING: From Pale to Bronze and Back Again . . . . . . . . . . 18 LIGHT FOR LIGHT: How New Light-Based Technologies Can Minimize the Signs of Long-Term Sun Damage . . . 23 The Tale of Tanning From Pale to Bronze and Back Again DEBORAH S. SARNOFF, MD Adapted from a presentation by Dr. Sarnoff at the 13th World Congress on Cancers of the Skin held in Madrid, Spain, April 7-10, 2010, and sponsored by Vichy Laboratories. The presenta-tion was based on the ﬁ ve-volume series 100,000 Years of Beauty , edited by Elisabeth Azoulay, Angela Demain, and Dalibor Frioux. that you could afford to stay out of the sun and spend time and money cultivating your appearance. IDEAL SKIN IN ANCIENT EGYPT Meet Prince Re-hotep (opposite page, top left), high priest of Heliopolis (circa 2,580 BC), and his wife Nofret, whose name means “the beauty.” 2 Nofret, whose statue was discovered near Memphis in 1871, has the pale, smooth skin so admired by ancient Egyptians. Nofret’s fair complexion reﬂ ects her high rank. She maintained her skin tone with powders and lotions made from tree resins like myrrh and frankincense, and used pigments like yellow ochre to make her skin pale and clear. T anning is a fairly recent trend. Tanned skin is not, nor has it ever been, a universally accepted ideal. Today “ideal” skin color varies among different cultures. For example, Caucasian women in Europe, the US, and Brazil often want to look tan, while women in China, Korea, and Thailand want to look fairer, more pink in tone. Both Indian men and women use “fairness creams” to lighten the complexion; these are THE MIDDLE AGES supposed to guarantee “success in Of the nomadic North Africans of the Sahara Desert, the Islamic Moroccan business and love.” 1 Historically, pale skin has indicated scholar Ibn Battuta wrote in 1356, high status. A tan signiﬁ ed that you “Bardama women are the most perfect had to work outdoors as a manual in terms of beauty — outwardly most laborer, while pale skin announced extraordinary, ﬂ awlessly white and 18 very plump.” 3 The women achieved their pale skin (and possibly their plumpness) by staying in their tents, and avoiding the harsh sun. In Europe, pale skin was likewise a sign of privilege, and when the upper classes went out riding on horseback, they applied lotions made of violet and rose oils to protect their skin from the sun. 4 In Japan from the eighth century on, female beauty was associated with a white face — the so-called white mask, or o-shiroi . This was achieved with lead-or mercury-based powders, which were applied to the face. Red tints ( beni-bana ) then colored the cheeks. 5 As in Japan, Chinese women pow-dered their faces white, and applied color to their cheeks. 6 A pale complex-ion was the accepted aesthetic ideal. In 1671 the writer Li Yu praised the wearing of dark blue clothes, since “it makes light complexions even lighter, and if those with darker complexions wear it, the darkness of their complex-ion is less easily discerned.” 7 S K I N CA N C E R F O UND A T I O N J O URN A L

The Tale Of Tanning: From Pale to Bronze and Back Again

Deborah S. Sarnoff, MD

Adapted from a presentation by Dr. Sarnoff at the 13th World Congress on Cancers of the Skin held in Madrid, Spain, April 7-10, 2010, and sponsored by Vichy Laboratories. The presentation was based on the five-volume series 100,000 Years of Beauty, edited by Elisabeth Azoulay, Angela Demain, and Dalibor Frioux.

Tanning is a fairly recent trend. Tanned skin is not, nor has it ever been, a universally accepted ideal. Today "ideal" skin color varies among different cultures. For example, Caucasian women in Europe, the US, and Brazil often want to look tan, while women in China, Korea, and Thailand want to look fairer, more pink in tone. Both Indian men and women use "fairness creams" to lighten the complexion; these are supposed to guarantee "success in business and love."1

Historically, pale skin has indicated high status. A tan signified that you had to work outdoors as a manual laborer, while pale skin announced that you could afford to stay out of the sun and spend time and money cultivating your appearance.

IDEAL SKIN IN ANCIENT EGYPT
Meet Prince Re-hotep (opposite page, top left), high priest of Heliopolis (circa 2,580 BC), and his wife Nofret, whose name means "the beauty."2 Nofret, whose statue was discovered near Memphis in 1871, has the pale, smooth skin so admired by ancient Egyptians.

Nofret's fair complexion refl ects her high rank. She maintained her skin tone with powders and lotions made from tree resins like myrrh and frankincense, and used pigments like yellow ochre to make her skin pale and clear.

THE MIDDLE AGES
Of the nomadic North Africans of the Sahara Desert, the Islamic Moroccan scholar Ibn Battuta wrote in 1356, "Bardama women are the most perfect in terms of beauty – outwardly most extraordinary, fl awlessly white and very plump."3 The women achieved their pale skin (and possibly their plumpness) by staying in their tents, and avoiding the harsh sun. In Europe, pale skin was likewise a sign of privilege, and when the upper classes went out riding on horseback, they applied lotions made of violet and rose oils to protect their skin from the sun.4

In Japan from the eighth century on, female beauty was associated with a white face – the so-called white mask, or o-shiroi. This was achieved with lead- or mercury-based powders, which were applied to the face. Red tints (beni-bana) then colored the cheeks.5

As in Japan, Chinese women powdered their faces white, and applied color to their cheeks.6 A pale complexion was the accepted aesthetic ideal. In 1671 the writer Li Yu praised the wearing of dark blue clothes, since "it makes light complexions even lighter, and if those with darker complexions wear it, the darkness of their complexion is less easily discerned."7

THE EARLY MODERN ERA
Fair skin remained highly valued in Europe. During the reign of Louis XIV (1638-1715), members of the Sun King's royal court strove for a flawless, white complexion.8 Fashionable French society avoided the sun, and also used skin-whitening cosmetics to help conceal scars that were so common in an era when diseases like smallpox left the skin covered in blemishes and pockmarks.

Powders such as "Spanish white," made of mercury, and "pearl white," which contained white lead (we know now that those weren't great health choices either!), were combined with greasy substances like wax, whale blubber and vegetable oil, and applied to the face. Over this base layer, rouge was painted onto the cheeks all the way up to the eyes. The red coloring agents (such as red lead and cinnabar) were also toxic, and longterm use could lead to skin damage; loss of teeth; lead poisoning; eyesight problems, and neurological disorders.9

THE 18TH AND 19TH CENTURIES
By the end of the 17th century, French doctors, concerned about the longterm effects of harmful mercury- and lead-based cosmetics, successfully campaigned for the outlawing of these toxic ingredients.10

As use of cosmetics spread throughout France, the upper classes sought to differentiate themselves with more subtle, natural-looking makeup.11 During the Victorian era, female beauty was closely associated with notions of purity and innocence. Makeup suggested artfulness and coquetry, and its use was considered inappropriate for proper 19th century girls. Of course, women still used cosmetics, but the alabaster face of the 18th century was abandoned in favor of a more subtle, naturallooking visage. Nineteenth century women also continued to avoid the sun, carrying parasols outdoors and wearing large straw hats to keep their complexions pale.12

THE SUN'S CHANGING ROLE
The sun became associated with health when Arnold Rikli, the "sun doctor," first used light therapy to treat consumption (tuberculosis) in Slovenia in 1855. Sunlight was also used to treat depression and even madness.13

In the 1920s, pioneering designer and fashion icon Coco Chanel popularized the idea of tanning, and the sun started to represent pleasure and relaxation as well as health.14

Once tans became popular, sunburn was inevitable, and soon the search was on for a product that would allow burn-free tanning. The tanning oil Huile de Chaldée, created by perfumer Jean Patou and introduced in 1927, promised to "put an end to sunburn, soften and tan the skin." Eugène Schueller (the founder of the company that would later become L'Oréal) enlisted his research team to develop a product that could prevent the sunburns he received while sailing "without forgoing the tan factor"; Ambre Solaire was the result.15 With benzyl salicylate as a UV absorber,16

Ambre Solaire appeared in April, 1935, just a year before the introduction of annual paid leave in France.17 Paid leave would encourage more people to travel – often to warm, sunny climes where it was easy to obtain a tan.

THE DARK AGE
Just as in the past pale skin had been a mark of privilege, from the 1960s on, a tan announced that you had the leisure to bronze your skin and the money to travel to places where one could be acquired. A tan also suggested enthusiasm for outdoor activities, and, by implication, physical fitness and good health.18

Of course, not everyone had the time or money to take a tropical vacation, but with the development and growth of the artificial tanning market, more and more people were able to give that impression. The first self-tanner, Man-Tan, was introduced in 1959,19 and UV tanning beds started to appear in the US in 1978.20 By the 1980s and 1990s both practices were firmly established in the US.21

A RAY OF LIGHT
However, recently the appeal of the tan has been fading. Today we know that 90 percent of all skin cancers are associated with exposure to the sun's ultraviolet (UV) radiation, which is also linked to eye damage, immune system suppression, and up to 90 percent of the changes commonly attributed to aging, including wrinkles, leathery skin and brown spots.

As the public has become aware of the long-term risks and results of suntanning and using artificial UV tanning beds, truly health-conscious, stylesavvy individuals have abandoned tanning to embrace sun protection and their own natural skin tones. As Sarah Brown, Vogue's Beauty Director, commented: "A healthy glow does not mean a tan, and I think that's what we have to clear up. A healthy glow is your skin tone, glowing." In 2008, The Skin Cancer Foundation appealed to people to stop tanning with the launch of Go With Your Own Glow™, a PSA ad campaign. Developed to encourage women to love – and protect – their skin, whatever its natural hue, the campaign has received $4.4 million in donated ad space and has reached more than 360 million readers. In the future, perhaps skin that is neither artificially whitened nor UV-damaged will become the new standard for beauty and health.

DR. SARNOFF, a Clinical Professor of Dermatology at NYU Langone School of Medicine, is in private practice in Manhattan and Long Island. She is also Senior Vice President of The Skin Cancer Foundation. Dr. Sarnoff coauthored Beauty and the Beam: Your Complete Guide to Cosmetic Laser Surgery and Instant Beauty: Getting Gorgeous on Your Lunch Break.

Keep tanning. You look great in leather.

Next time you think about tanning, think about the long-term effects. Protect your skin. Go with the beauty you were born with. It looks great on you.